Aneurismas Gigantes do Septo Interauricular Simulando Massas Quísticas. Dois Casos com Opções Terapêuticas Diferentes

With the recent technical improvement in echocardiography imaging (second harmonics) the number of interatrial septum aneurysms (ASA) increased and are easily recognized. We assist to an overdiagnosing number of cases and diagnostic criteria emerged to face this problem. In the great majority of the cases ASA are small and inoffensive, but as ASA is considered a risk factor for cardioembolism when associated with persistence of foramen oval (PFO), an examination by transesophageal echocardiography (TEE) for exclusion of PFO makes the sense and is a common testing in patients with cryptogenic stroke. Besides these frequent ASA, other forms exist; the authors describe two cases of uncommon and huge ASA, one mimicking a right atrial tumor and the other a quistic, hipoechoic mass. The first case was associated with mitral stenosis and was submitted to surgery and the second was closed with an Amplatzer occluder device usually used in atrial septal defect (ASD)

Percutaneous Pulmonary Valve Implantation: Initial Experience

Os doentes com cardiopatias submetidos a intervenção cirúrgica com implantação de condutos entre o ventrículo direito e a artéria pulmonar (VD-AP) podem desenvolver estenose e/ou insuficiência pulmonares ao longo do tempo. Nestas situações, associadas a arritmias cardíacas, disfunção ventricular direita e morte súbita, a re-intervenção cirúrgica permanece um desafio pela complexidade, mortalidade e morbilidade significativas. A implantação percutânea de válvulas pulmonares (IPVP), recentemente desenvolvida, representa uma abordagem alternativa para estes doentes. Objectivo: Reportar a experiência inicial com a IPVP, analisando o seu impacto no manejo destes doentes. Material e Métodos: Avaliação prospectiva dos dados clínicos, ecocardiográficos, da ressonância magnética, hemodinâmicos e angiográficos dos doentes submetidos a IPVP. Resultados: Seis doentes em classe funcional igual ou superior a II com disfunção do conduto VD-AP foram submetidos a IPVP. Tinham todos evidência de insuficiência e 5/6 de estenose. O procedimento consistiu na implantação de stents não cobertos no conduto para reforçar a sua rigidez e prevenir fracturas dos stents valvulados pulmonares Melody ® (Medtronic), que foram em seguida implantados com sucesso em todos. Obteve-se uma redução da pressão ventricular direita (94±27 para 44±7mmHg), da relação entre a pressão ventricular direita e esquerda (94±27 para 44±7%), do gradiente do conduto (65±28 para 11±4mmHg) e ausência de regurgitação pulmonar. O procedimento teve uma duração mediana de 180 minutos e decorreu sem complicações major. Os doentes tiveram alta em mediana dois dias após o procedimento. Na última avaliação, em mediana 7,8 meses após o procedimento, os doentes encontramse em classe funcional I (5) ou II (1), sem evidência não invasiva de disfunção do conduto. Conclusões: Os nossos resultados acompanham a experiência actual com esta modalidade terapêutica, com excelentes resultados nestes grupo de doentes complexos. A implementação da IPVP em doentes com cardiopatia congénita que requerem re-intervenção no tracto de saída do ventrículo direito tem-se revelado uma técnica promissora, embora complexa, alternativa a mais uma intervenção cirúrgica

Percutaneous Closure of Atrial Septal Defects: a Decade of Experience at a Reference Center

INTRODUCTION: Atrial septal defects (ASD) are among the most common congenital anomalies and account for 10% of congenital heart disease in the pediatric age-group and 30% in adults. Closure is indicated when there is evidence of hemodynamic significance or after a paradoxical embolic event. Ten years ago, percutaneous closure became the treatment of choice in our center for all patients with a clear indication and favorable anatomy. In this paper we report the experience of this first decade. OBJECTIVE: To assess the short- and long-term results of our ten-year experience with percutaneous closure of atrial septal defects. METHODS: We studied retrospectively all patients with ASD treated with a percutaneous approach between November 1998 and December 2008. The pediatric age-group consisted of patients younger than 19 years old. Demographic data, clinical indications, minor and major complication rates, success rate and long-term outcome were assessed. RESULTS: In the first ten years of experience 510 patients, of whom 166 were in the pediatric group, were treated in our center by a team of adult and pediatric cardiologists. The overall success rate of the procedure was 98% (97.5% in ASD and 99.5% in patent foramen ovale (PFO). The minor complication rate was 3% (3.4% in ASD and 2% in PFO). The most frequent complication was supraventricular tachycardia. The major complication rate was 1.2% (0.6% in ASD and 2% in PFO). Two patients developed cardiac tamponade due to hemopericardium that was resolved by pericardiocentesis, without need for surgery. One patient had an arterial pseudoaneurysm corrected by vascular surgery. There was no device embolization and no need for urgent surgery in this population. During follow-up two patients had recurrence of ischemic stroke, one had a transient ischemic attack and another had a hemorrhagic stroke. Mortality was 0.6% (0.6% in ASD and 0.5% in PFO). There were no in-hospital deaths. During follow-up there were two deaths, both in the adult group. DISCUSSION AND CONCLUSION: In this population the success rate was high and most of the complications were minor. The results of this collaboration between adult and pediatric cardiologists in the first ten years of activity confirm the safety and efficacy of percutaneous closure of septal defects, when there is careful patient selection and a standardized technique

Encerramento Percutâneo de Comunicação Interauricular Residual por Falência de Dispositivo

A 39-year-old woman underwent uneventful percutaneous occlusion of an ostium secundum atrial septal defect (ASD) with a 22 mm Ultrasept ASD Occluder®. Transesophageal echocardiography (TEE) performed two years after implantation revealed a de novo residual left-to-right shunt through the correctly implanted device. Three-dimensional transesophageal echocardiography (3D TEE) further clarified this finding by showing a perforation of the device membrane coating. The patient underwent transcatheter closure of the residual shunt with a 20 mm Ultrasept PFO®device. The procedure was guided by fluoroscopy and real-time 3D TEE. At the end of the procedure 3D TEE documented correct device deployment with complete defect coverage and absence of residual shunt.info:eu-repo/semantics/publishedVersio

Consumo calórico, necesidades energéticas y masa grasa en boxeadores al inicio de la preparación física

Background: the purpose of this study is to compare the nutritional intake, fat mass and VO2max between amateur and professional boxers at the beginning of the season, as well as the nutritional requirement and consumption within and between groups and the percentage of intergroup nutritional adequacy. Methods: a non-experimental, cross-sectional cohort study was conducted with 41 male boxers (26 professionals and 15 amateurs; M=20.29±3.29 years). The sample was selected for convenience and was stratified by sports mastery Student's t tests were applied to compare the inter- and intra-group variables and significance of p≤0.05. Results: greater energy needs were observed in professional boxers, although deficient in both groups with respect to daily caloric intake (p<0.05), mainly due to carbohydrate intake (5.68±1.72gr/kg/body weight; amateurs and 5.63±2.18gr/kg/body weight; professionals). Both groups presented imbalance in the intake of micronutrients, mainly iron, sodium, zinc, ascorbic acid, tocopherol and retinol. Conclusions: there was a deficient daily caloric intake in both groups of boxers with intra- and intergroup micronutrient imbalances, which could negatively affect the physical performance of the boxers at some stage of training.Antecedentes:  el propósito del presente estudio fue comparar la ingesta nutrimental, masa grasa y VO2máx entre boxeadores amateur y profesionales al inicio de temporada, así como el requerimiento y consumo nutrimental intra e inter grupos y el porcentaje de adecuación nutrimental intergrupo. Métodos: se realizó un estudio de cohorte transversal y no experimental con 41 boxeadores del sexo masculino (26 profesionales y 15 amateurs; M=20.29±3.29 años).  La muestra fue seleccionada por conveniencia y se estratificó por maestría deportiva. Se aplicaron pruebas t de Student para comparar las variables inter e intra grupos y significancia de p≤0.05. Resultados: se observó mayor necesidad energética en boxeadores profesionales, aunque deficiente en ambos grupos respecto a la ingesta calórica diaria (p<0.05) principalmente por el consumo de carbohidratos (5.68±1.72gr/kg/peso corporal; amateurs y 5.63±2.1872gr/kg/peso corporal; profesionales). Ambos grupos presentaron desequilibrio en la ingesta de micronutrimentos, principalmente en hierro, sodio, zinc, ácido ascórbico, tocoferol y retinol. Conclusiones: existió deficiente ingesta calórica diaria en ambos grupos de boxeadores con desequilibrio de micronutrimentos intra e intergrupo los cuales pudieran afectar negativamente el rendimiento físico de los boxeadores en alguna etapa de entrenamiento

Paediatric obsessive-compulsive disorder and depressive symptoms: clinical correlates and CBT treatment outcomes.

Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 - 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 - 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms

Genetic parameters and selection strategies for soybean genotypes resistant to the stink bug-complex

Soybean genotypes resistant to stink bugs are derived from complex breeding processes obtained through indirect selection. The aim of the present work was to estimate genetic parameters for guiding selection strategies towards resistant genotypes, based on those traits associated with responses to pod-attacking stink bugs, such as the grain filling period (GFP), leaf retention (LR), percentage index of pod damage (PIPD) and percentage of spotted seeds (PSS). We assessed the parental lines IAC-100 (resistant) and FT-Estrela (susceptible), the progenies F2 and F 4 , 30 progenies F 2:3 , 30 progenies BC 1 F 2:3 and 30 progenies BC 2 F 2:3 , besides the cultivars BRS Celeste and MGBR-46 (Conquista). Three field experiments, using randomized complete block design with three replications, were installed in Goiânia-GO, in the 2002/03 season. Each experiment consisted of 36 treatments (6 common and 30 regular). Heritability estimates were: 74.6 and 36.1 (GFP); 51.9 and 19.9 (LR); 49.6 and 49.6 (PIPD) and 55.8 and 20.3 (PSS), in both the broad and narrow senses, respectively. Based on these results, we concluded that the best strategy for obtaining stink bug-resistant genotypes consists of selecting the PIPD trait in early generations (F 3 or F 4 ), followed by selection for the GFP, LR and PSS traits in generations with higher endogamy levels